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2 . 2021

A variant of blood, warm, low-volume, single-dose cardioplegia for myocardial revascularization

Abstract

It was a prospective, single-center trial of the primary coronary artery bypass grafting hospital outcomes with two different types of cardioplegic myocardial protection performed as follows: own modification of warm, blood, low-volume, single-dose cardioplegia and cold crystalloid cardioplegia with NTK-solution. The study was carried out between 2016 and 2019. The proposed modification of cardioplegia was used in 1735 patients. 376 of those patients were included in the main group (blood cardioplegia group). Control group (crystalloid cardioplegia group) consisted of 324 patients. Inclusion criteria were similar for both groups: scheduled primary multiple coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB), revascularization index of ≥2, comparable values according to the coronary bed lesion severity rating scale (Syntax SCORE), aortic occlusion time ranged from 50 to 70 min. The data is represented as Me (min-max).

The AV block was the underlying mechanism resulting in asystole in 100% of patients (p<0.001) in the blood cardioplegia group and ventricular fibrillation (VF) (p<0.001) was the main reason in 84% of patients included in the crystalloid cardioplegia group. After the aortic cross-clamp was removed, the unaided heart activity recovery was found in 84% (317 patients) in the blood cardioplegia group vs 68% (200 patients) in the crystalloid cardioplegia group (p=0.001) (VF) and the need for defibrillation was 6 vs 32% (p<0.03) respectively. Patients in the crystalloid cardioplegia group had a more outstanding volemic load: postoperative balance in the crystalloid cardioplegia group (Me 1720 vs 1350 ml; p=0.001) and the need for hemotransfusion (28 vs 19.2%; p=0.001). Inotropic and/or vasopressor therapy was used more frequently during the perioperative period (31 vs 12%; p=0.01) in the crystalloid cardioplegia group. The blood cardioplegia group demonstrated less enzymatic activity (p<0.001) when assessing the values of markers for myocardial injury such as CPK-MB isozyme (creatine CPK-MB) and troponin T in 24 hours after the aortic occlusion was relieved. There were no deaths in the blood cardioplegia group while 2 (0.6%) patients died in the crystalloid cardioplegia group. The other parameters considered are as follows: the frequency of myocardial infarction, low cardiac output syndrome, postoperative AF, CVA; duration of hospital stay did not significantly differ between the groups (p>0.05).

Conclusion. The proposed method of blood, antegrade, low-volume, single-dose cardioplegia is easy to perform and is a reliable, safe way to protect the myocard during CABG with cross-clamp period of 50-70 min.

Keywords:cardiopulmonary bypass, myocardial revascularization, myocardial protection

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Bazylev V.V., Evdokimov M.E., Pantyuhina M.A. A variant of blood, warm, low-volume, single-dose cardioplegia for adult myocardial revascularization. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (2): 68-75. DOI: https://doi.org/10.33029/2308-1198-2021-9-2-68-75 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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